A minority of patients with recurrent mouth sores have gluten-sensitive enteropathy, making evaluation for celiac disease appropriate in this population, according to a new study in BMC Gastroenterology.
Gluten-sensitive enteropathy, or celiac disease, is an inherited autoimmune disorder in which the lining of the small intestine is damaged from eating gluten and other proteins in wheat, barley, rye, and possibly oats.
The sores could be the only manifestation of celiac disease for 5 percent of the patients, wrote Dr. Farhad Shahram of Tehran University of Medical Sciences, Iran, and colleagues.
The mouth sores, called aphthous stomatitis, are painful open ulcers, such as canker sores, that are white or yellow and surrounded by a bright red area. They tend to reappear in times of stress and are associated with viral infections, food allergies, and other conditions.
The researchers studied 247 patients, with an average age of 33, who had at least three aphthous attacks during the year. The team measured antibodies and other immune factors associated with celiac disease, and patients with negative results were excluded.
Those with positive results underwent biopsies of the lining of the small intestine. Gluten-sensitive enteropathy was defined as a positive blood test for immune factors and abnormal biopsy results. A gluten-free diet was recommended for patients with gluten-sensitive enteropathy.
Seven patients with positive blood tests underwent upper GI endoscopy and duodenal biopsies. Endoscopic findings were compatible with gluten-sensitive enteropathy in two patients and were normal in five patients. However, biopsy findings were compatible with gluten-sensitive enteropathy in all seven patients.
The patients with gluten-sensitive enteropathy were an average age of 27, and the average duration of the disease was 4.5 years. The seven celiac disease patients had not responded to conventional mouth ulcer medications, including topical corticosteroids, tetracycline, and colchicine.
Four of the seven celiac disease patients started a strict gluten-free diet. All showed a significant improvement within two to six months.
SOURCE: BMC Gastroenterology 2009.
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